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<br />i I <br /> <br />P!tRMPr ~PPLlCATION <br /> <br />UTILmES LOCATE CONFIRMATION NUMBER: <br /> <br />PROVID SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br />APPLIC TION. <br /> <br />AFADAVIT: Application is hereby made to obtain a pennit to do work and installations as indicated. I certify that all foregoing <br />infonnation s accurate and that all work will comply with all applicable codes. I understand.these codes shall take precedence over all <br />approved nstructlon documents, and issuance of this pennit is verification that I will notify the property owner of Rorlda Lien Law <br />req., F.S. 7 3. <br /> <br />The iss ance of this permit does not ensure compliance with deed restrictions and I understand that additional deed <br />restrictions may apply to this property. <br /> <br />all comply with the current Florida Building Code, Public Works Design Manual and FDOT Design <br />ndards (If applicable). (Public Works Design Manual online link: www.d.zephyrhills.f1.us/public_works.asp) <br /> <br />lION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br />TECHNICIAN OR NOTARY PUBUC. <br /> <br /> <br />NOTE: <br /> <br />city of Zephyrhills is not responsible for maintenance or repairs of driveways. Driveways shall not alter I <br />Interfere with existing stonnwater treabnent and I or' conveyance. <br /> <br />By signing this application: I certify that I ve rea, and understan e owner/builder disclosure <br />(please initial) :>/t ~. <br /> <br />/ l'/t aro <br /> <br />Date <br /> <br />(or) Notary Signature <br /> <br />Applicant is ) personally known to me or produced <br /> <br />as identification, <br /> <br />(type of identification) <br /> <br />Page 2 of 3 <br />